The rupture of the anterior cruciate ligament is one of the most common injuries in sports that require dynamic stability of the lower limbs, characterized by rapid changes in direction, high speed, decelerations, and jumps, as is the case in skiing.
Anterior cruciate ligament (ACL) injuries are usually caused by a combination of factors, including snow conditions, the speed reached, the equipment used, and, most importantly, the skier’s technique and physical condition. Recent data from the International Ski Federation (FIS) document that in the World Cup (WC), at least 1 in 3 skiers suffers an injury, and during races, the incidence rate is 9.8 injuries per 1,000 runs. Similar to amateur skiers, the most common injury among professional skiers is a rupture of the anterior cruciate ligament (ACL).
Risk Factors
The main modifiable risk factors associated with this injury involve knee control, the strength of the quadriceps, hamstrings, and the interaction between these two muscle groups. Neuromuscular training aimed at strengthening both the quadriceps and hamstrings has been shown to reduce the risk of ACL injuries. Additionally, core strength plays an important role in preventing such injuries. Skiers who have suffered an anterior cruciate ligament injury tend to exhibit reduced core strength and lower trunk mobility, particularly in flexion-extension, compared to those who have not been injured.
Another significant risk factor is skier fatigue, as evidenced by the fact that injuries in alpine skiing competitions primarily occur during the final stages of a race, when fatigue is more pronounced compared to the beginning. Therefore, to reduce the frequency of injuries, it is essential to develop training programs that focus not only on strength but also on fatigue resistance.
Returning to the Slopes After an Injury
For skiers returning to the slopes after anterior cruciate ligament (ACL) reconstruction, 19% report a new injury to the same knee, while 31% experience bilateral ACL injuries. These figures highlight the importance of a functional evaluation before returning to skiing, as the tests performed can indicate a potential risk of re-injury. Among the recommended assessments are tests to measure functional asymmetry, the muscle strength of the thigh’s flexor and extensor muscles, such as the isokinetic test, and aerobic condition through a threshold test.
A study has shown that impaired neuromuscular control of the knee and hip, along with poor postural stability, are often causes of a second anterior cruciate ligament injury after returning to sports following ligament reconstruction.
Keyword: Prevention
Preventing anterior cruciate ligament (ACL) injuries in skiing is essential to reduce the risk of accidents; skiers can adopt a range of strategies to improve knee stability and mitigate risk factors.
Targeted training to improve neuromuscular control of the knee is one of the most effective approaches to preventing ACL injuries. This type of training focuses on enhancing strength, coordination, and balance, particularly in the muscles that stabilize the knee.
Therefore, exercises aimed at strengthening the quadriceps and hamstrings, proprioception exercises to improve knee stability, jump and controlled landing drills to teach the body to manage impact and forces during rapid movements, and core strengthening exercises with trunk rotations and back extensions to enhance mobility and stability are of fundamental importance.
